Fluoroscopy (Radiography) – Lower GI Tract

Lower or upper gastrointestinal tract radiography uses a form of real-time x-ray called fluoroscopy and a barium-based contrast material to help detect disease and abnormalities and diagnose symptoms such as pain, constipation or blood in the stool. It can often provide enough information to avoid more invasive procedures such as colonoscopy.

Tell your doctor if there's a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking and allergies, especially to contrast materials. You doctor will instruct you on how to cleanse your bowel, restrict you to clear liquids on the day before your procedure, and not allow you to eat or drink anything after midnight. Take your regular medication with sips of water.

Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

WHAT IS FLUOROSCOPY?

Fluoroscopy is a non-invasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

The lower GI uses a special form of x-ray called fluoroscopy and a contrast material called barium or water-soluble iodinated contrast. Fluoroscopy makes it possible to see internal organs in motion. When the lower gastrointestinal tract is filled with barium, the radiologist is able to view and assess the anatomy and function of the rectum, colon and sometimes part of the lower small intestine.

Upper gastrointestinal tract radiography, also called an upper GI, is an x-ray examination of the esophagus, stomach and first part of the small intestine (also known as the duodenum). Images are produced using a special form of x-ray called fluoroscopy and an orally ingested contrast material such as barium.

WHAT ARE SOME COMMON USES OF THE PROCEDURE?

The procedure is frequently performed to help diagnose symptoms such as:

• Chronic diarrhea.
• Blood in stools.
• Constipation.
• Irritable bowel syndrome.
• Unexplained weight loss.
• Swallowing issues.

Images of the small bowel and colon are also used to diagnose inflammatory bowel disease, a group of disorders that includes fecal incontinence, Crohn's disease and ulcerative colitis.

HOW SHOULD I PREPARE FOR THE PROCEDURE?

Your physician will give you detailed instructions on how to prepare for your lower GI imaging. You should inform your physician of any medications being taken and if there are any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

On the day before the procedure you will likely be asked not to eat, and to drink only clear liquids like juice, tea, black coffee or broth, and to avoid dairy products. After midnight, you should not eat or drink anything. For adults (but not usually in children), it is important that your colon be completely empty for the procedure. You may also be instructed to take a laxative (in either pill or liquid form) before the examination and possibly a few hours before the procedure. Just follow your doctor's instructions. You can take your usual prescribed oral medications with limited amounts of water.

You will be asked to remove some of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, removable dental appliances, eye-glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.

If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

WHAT DOES THE X-RAY EQUIPMENT LOOK LIKE?

The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.

HOW DOES THE PROCDURE WORK?

X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special detector.

Fluoroscopy uses a continuous or pulsed x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear dark (or by electronically reversing the image contrast to white), this special x-ray technique makes it possible for the physician to view joints or internal organs in motion. Still images or movies are also captured and stored electronically on a computer.

Most x-ray images are digital files that are stored electronically. These stored images are easily accessible for diagnosis and disease management.

HOW DOES THE PROCDURE PERFORMED?

A radiology technologist and a radiologist, a physician specifically trained to supervise and interpret radiology examinations, guide the patient through the barium enema. You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

Some x-ray equipment will allow patients to remain in the same position throughout the examination.

When the examination is complete, you may be asked to wait until the radiologist determines that all the necessary images have been obtained.

WHO INTERPRETS THE RESULT AND HOW DO I GET THEM?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time.

WHAT ARE THE BENEFITS VS. RISKS?

BENEFITS

• X-ray imaging of the lower and upper GI tract is a minimally invasive procedure with rare complications.
• Radiology examinations such as the lower GI can often provide enough information to avoid more invasive procedures such as colonoscopy.
• Because barium is not absorbed into the blood, allergic reactions are extremely rare.
• No radiation remains in a patient's body after an x-ray examination.
• X-rays usually have no side effects in the typical diagnostic range for this exam.

RISKS

• There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
• In rare cases, the barium could leak through an undetected hole in the lower GI tract producing inflammation in surrounding tissues.
• Even more rarely, the barium can cause an obstruction in the gastrointestinal tract, called barium impaction.
• Iodinated contrast administered rectally may cause allergic reactions, but this is very rare.
• Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.

A WORD ABOUT MINIMIZING RADIATION EXPOSURE

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals.

Modern x-ray systems have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures that those parts of a patient's body not being imaged receive minimal radiation exposure.

X-ray imaging is not usually indicated for pregnant women.